Listening to Patients


Research Raises Prospect Of Springtime Shot To Protect Against Lyme Disease


“Sign me up!”

That was my first, emphatic reaction to word that University of Massachusetts Medical School researchers are making progress toward a shot that we here in Lyme disease territory could get every spring for months-long protection through high tick season. It would use monoclonal antibodies — medical cruise missiles that can hit the narrowest of targets.

Sadly, the research, though promising, is still only in mice, and it will be years before such a shot could possibly be available in humans. But for those of us eagerly awaiting better protection against Lyme disease — not to mention those of us frustrated by this: Why your dog can get vaccinated against Lyme disease and you can’t — it’s heartening news nonetheless.

I asked for details from UMass Medical School professor Mark Klempner, a longtime Lyme disease researcher and executive vice chancellor of MassBiologics, a non-profit, UMass-affiliated maker of vaccines and other public-health-oriented medicines. His colleague, Dr. Yang Wang, just presented their team’s findings to a major conference on infectious disease in San Diego. His summary:

“For the past two-and-a-half years, MassBiologics has been developing a new approach to prevention of Lyme disease, as part of our overall public health efforts to protect the citizens of Massachusetts and beyond for diseases of interest.

We’ve taken a different approach than the vaccine approach, and what we’ve developed is a human monoclonal antibody that, when present in the blood of a host, will prevent the transmission of the Lyme disease bacteria from the tick to that host.

When the tick bites you, it then drinks in a little bit of your blood, and contained within that blood is the medicine that kills the bacteria right in the gut of the tick.

– Dr. Mark Klempner

I want to emphasize that so far these studies have been done exclusively in animals — so-called preclinical studies — and our future is to move this into clinical studies, which we will hopefully initiate in 2016.

The idea here is based on a couple of precedents. The first is: We know that the previously available [Lyme disease] vaccine worked by inducing many, many different antibodies, only one of which was important in the protection. And similarly, we know that there is a precedent for being able to give a safe and effective monoclonal antibody to young babies in order to prevent them from getting a different infectious disease called Respiratory Syncitial Virus.

So for both precedent and safety reasons, we chose to go after a single monoclonal antibody that would be able to prevent the transmission of Lyme disease during the entire season. The monoclonal antibody idea has additional benefit in that when the vaccine was available, it required three shots over six months to induce immunity, and so you needed to start to take the medicine sometime in the winter in order to be able to protected in the following fall, and there was not a lot of uptake of that.

Dr. Mark Klempner (Courtesy UMMS)

Dr. Mark Klempner (Courtesy UMMS)

So here, one of the advantages is that the antibody, if we give it to you, provides you immediate immunity, as it does in a mouse, and it should last for the entire season by engineering the antibody to have a very, very long half life. And then it would be gone at the end of the season, and the next season you would take the medicine again and it should work again for the entire season.

The overall mechanism of the way the antibody works is quite interesting and unique, and it’s really based on the idea that the way you catch Lyme disease is, obviously, by the bite of the tick, and what happens in the tick when it drinks your blood is that there’a a sudden explosion of the organisms in the intestine of the tick, where they begin to multiply very quickly; they change somewhat and then they invade the tick gut and move to the salivary gland, where, during the feeding process they can then be deposited in your skin, where you get that typical bullseye rash, often.

So here the idea is that if you have the circulating antibody going around when the tick bites you, it then drinks in a little bit of your blood and contained within that blood is the medicine that kills the bacteria right in the gut of the tick and thereby prevents transmission.

When we do these studies in mice, that’s exactly what happens. Continue reading

First Step In Better Care For LGBT Patients? Find Out Who They Are

The U.S. Department of Health and Human Services said this week that electronic health records must include options for collecting information about gender identity and sexual orientation.

“This is enormously important for transgender patients,” says Dr. Joshua Safer, associate professor of medicine at Boston University. “Knowing how treatments affect men and women, and people of a certain age, is important information for physicians caring for patients. But right now we can’t know that for transgender patients because their medical records aren’t categorized by the correct gender.”

Fenway Health calls the new requirement “landmark.”

Continue reading

Sad After Sex? New Study Suggests ‘Postcoital Dysphoria’ Is Widespread

A new study finds that 46 percent of women reported experiencing symptoms of postcoital dysphoria, or PCD, at least once in their lifetime, with 5.1 percent experiencing symptoms of the condition a few times within the past four weeks. (Peter Kelly/Flickr)

A new study finds that 46 percent of women reported experiencing symptoms of postcoital dysphoria, or PCD, at least once in their lifetime, with 5.1 percent experiencing symptoms of the condition a few times within the past four weeks. (Peter Kelly/Flickr)

For Kim, a 30-year-old teacher in North Carolina, it happens pretty much every time she has an orgasm: a feeling of profound sadness washes over her and she experiences a sense of regret. “It’s not that I don’t like sex,” she said in an interview. “I enjoy sex, I like to have orgasms, but after an orgasm, I feel this wave of sadness. It only lasts around a minute, but I’m just like, ‘Ugh, that doesn’t feel good.’ ”

For Kim’s sister, Rachel, 27, it’s even worse. She says that since she was a young adolescent, around 12 or 13, after an orgasm darkness and despair descends on her for 10 to 15 minutes. “It’s just really sad,” she said. “Almost like a feeling of homesickness, but I’m home. It happens every single time.”

Kim and Rachel (both happily married, they say, and both asking that their last names be omitted) had shared their intimate distress in the past — the topic came up when they both had a similar sadness breast-feeding their babies; a condition, they discovered, that’s known as dysphoric milk ejection reflex, or D-MER. But they didn’t fully realize their post sex sadness was “a thing” until they came across a Facebook post about a new study that called it by its official name: postcoital dysphoria, or PCD.

Also called “postcoital tristesse,” literally “sadness” in French, it’s a condition marked by feelings of melancholy, agitation, anxiety or sadness after intercourse that can last between five minutes and two hours. Sometimes there are tears.

If you look it up on Wikipedia you’ll learn “the phenomenon is traced to the Greek doctor Galen, who wrote, ‘Every animal is sad after coitus except the human female and the rooster.’ ”

Not true, according to the new study, published in the journal Sexual Medicine and led by researchers in Australia. They found that 46 percent of women reported experiencing PCD symptoms at least once in their lifetime with 5.1 percent experiencing symptoms of the condition a few times within the past four weeks.

There are big caveats. Data for the study were collected through an online questionnaire; female students over 18 who reported being sexually active were recruited via email at Australian universities and through Facebook. Ultimately, the total sample included 195 heterosexual, mostly white women, the study notes, and so the results can’t necessarily be generalized to the broader population. (Earlier estimates of the condition vary.)

“We go through life with our defenses up, and after sex, with that release, sometimes the feelings just flood in.”

– Psychologist and sex therapist Judy Silverstein

There are a number of theories on what’s behind PCD, and clearly more research is needed. Some say it’s hormones, others suggest the intense emotional release after sex let’s loose other deep emotions. Past sexual abuse may play a role in some cases, but this particular study suggests it’s not the main driver.

Judy Silverstein, a psychologist and sex therapist in Needham, Massachusetts, says she’s worked with many women who have tears or sadness after sex. She said she believes that biology, in addition to psychology, could be a factor.

“When orgasm occurs … there is a physiological release — after a buildup of sexual tension — which may lead to tears (or laughter) not accounted for by psychological variables,” she said. Continue reading

Op-Ed: A Few Things You May Not Know About The Senate Opioid Bill

By State Sen. John Keenan, of Quincy 

In the midst of an opioid addiction crisis that has claimed over 1,200 deaths in 2014 and thousands more in the preceding decade, the state Senate has passed a bill intended to help prevent opioid addiction. There’s more to it than most have realized.

You’ve probably read about the proposed expansion of so-called Screening, Brief Intervention and Referral to Treatment (SBIRT) programs in public schools — a proposal initially deemed controversial, with people believing it involved blood samples and lab testing. Even my mother called to report her concerns, and conveyed that my 88-year-old aunt was also opposed. For the record, the Senate bill does not include any drug testing. It does include a verbal survey and assessment, of students, to gain a better understanding of trends and risks among youth.

Continue reading

Medical Marijuana Sales Climb As More Dispensaries Open

It looks like supporters of medical marijuana were right. There appears to be a lot of pent-up demand from patients who want weed.

Patients purchased 1,676 ounces in September, as the state’s second dispensary opened in Brockton. That’s a big jump from the 1,488 ounces sold in the two months prior, when only one dispensary, in Salem, was cleared to sell medical marijuana in the state.

The sales data was released for the first time Thursday, on a dashboard created by the state Department of Public Health.

Source: Massachusetts Department of Public Health (Click to enlarge)

Source: Massachusetts Department of Public Health (Click to enlarge)

DPH says it appears as if very few patients are buying up their allowed limit.

“Right now it does appear as people are buying a small amount of marijuana per transaction,” said Scott Zoback, a DPH spokesman. “That is something we continue to watch.”

The allowed limit is up to 10 ounces in a 60-day period, although that has been reduced to 4.23 ounces as the state reviews safety testing criteria.

Some patients report that dispensaries are restricting the amount of each sale in order to stretch a supply that is not meeting demand.

In Good Health, the Brockton store, was so busy it closed for several days toward the end of September. A spokesman said demand exceeded supply and the dispensary ran low because there were delays at one of the labs that tests medical marijuana before it is cleared for sale.

Continue reading

Economist Heidi Williams, Genius Award Winner, On Invisible Drug Industry Incentives

Last week, as she was sitting in her office at MIT, 34-year-old economist Heidi Williams got an unexpected phone call. It was from the John D. and Catherine T. MacArthur Foundation, telling her that she had just been awarded a so-called “Genius Award” — a no-strings-attached $625,000 grant that celebrates “the creative potential” of its fellows.

Williams, an assistant professor of economics at MIT, researches how invisible economic incentives affect the kind of cures that the medical industry produces. Her research has found that researchers are more likely to develop cures for late-stage cancer patients than early-stage patients, for instance, and that intellectual property law can limit innovation in genome research.

Radio Boston’s Anthony Brooks spoke with Williams about her research and her award (the interview airs in an upcoming show). Their conversation, edited:

AB: Tell us how you got the news about this award, and your reaction to it.

HW: I got a phone call from an area code that I recognized as a Chicago number. And I was just completely speechless when I answered the phone and talked to them. I’m very early in my career, and I was just completely overwhelmed to hear that I had received a fellowship.

Talk to me about these invisible economic incentives that affect the cures that the medical industry produces. Can you explain how this works?

Researchers working on drug treatments often come up with a lot of ideas, but if you talk to them, many of those ideas just never reach patients. Sometimes you hear anecdotes about the reason why those products never got developed — because of misaligned incentives in the patent systems or because of misaligned incentives in the policy system more generally. I try to explain why some promising scientific leads never get developed into new drugs or medical technologies that consumers or patients actually have access to.

Why are there incentives for late-stage cancer treatment for example, but few for early-stage cancer, or even cancer prevention? What incentives control that?

When new drugs come to market in the U.S., they need to show the U.S. government evidence that the drugs are safe and effective by showing evidence that the drug improves survival. When you need to show that a drug improves survival for patients that are very sick and will die relatively quickly, you can show that in a randomized clinical trial much more quickly than if you need to show evidence that a drug improves the survival of patients that have a longer life expectancy.

Longer clinical trials take more time and cost more money, but also, biotech and pharmaceutical companies almost always file for patent protection before they start their clinical trials. And so every additional amount of time that they’re spending in clinical trials is less time that they have for their patent to actually be generating profits for them once their drug is on the market. Continue reading

More Evidence Points To Big Differences In C-Section Rates At Mass. Hospitals

There’s no question that some women need a Cesarean section for the safe delivery of their child. (I’m one of them.) But there’s widespread agreement that too many women in the U.S. have C-sections, increasing the risks for the mother and baby — as well as the costs of their care.

The employer-backed group Leapfrog is out with a national comparison of C-section rates. It says a C-section rate of 23.9 percent is a reasonable standard. Massachusetts ranks 19th among all states, with an average C-section rate of 26.2 percent.

Source: Leapfrog (Click to enlarge)

Source: Leapfrog (Click to enlarge)

“The first thing you should look at in selecting a hospital or doctor is the C-section rate, and your chances of needing a C-section when you deliver,” said Leapfrog President and CEO Leah Binder. “It’s very important to investigate that right away.”

Here are the three hospitals in Massachusetts with the lowest C-section rates, as reported to Leapfrog:

  • Harrington Memorial Hospital in Southbridge — 14.3 percent
  • Fairview Hospital in Great Barrington — 15.2 percent
  • Cambridge Health Alliance in Cambridge — 18.5 percent

And the three Massachusetts hospitals with the highest C-section rates:

  • Holy Family Hospital in Methuen — 42.7 percent
  • Steward Good Samaritan Medical Center in Brockton —  36.4 percent
  • Tufts Medical Center in Boston — 36.3 percent

You can see how all Massachusetts hospitals that report to Leapfrog compare here, as well as which hospitals decline to report their C-section rates — something that raises a red flag for Binder.

“The hospitals to worry about most are those that decline to report this data,” Binder said. “There are hospitals in Massachusetts that decline to report and you have to wonder why they did that.”

So why the big differences?

Continue reading


Can Musical Training Help Fix ‘The Cocktail Party Problem?’



By Barbara Moran

An earlier version of this post appeared on the Boston University Research News website under the headline, “The Cocktail Party Problem.”

Alan Wong first noticed the problem a few years ago. In a crowded bar or restaurant, he could barely understand his companion’s conversation. Wong, 35, blames the problem on a well-spent youth: “I went to a lot of loud concerts in my 20s, and now my hearing sucks,” says Wong, executive producer at Boston University Productions. “It’s a bummer,” he adds, “especially when I have a hard time hearing the lady friends.”

Scientists call it the “cocktail party problem,” and it’s familiar to many people, even those who pass standard hearing tests with flying colors: they can easily hear one-on-one conversation in a quiet room, but a crowded restaurant becomes an overwhelming auditory jungle. For people with even slight hearing problems, the situation can be stressful and frustrating. For those with significant hearing loss, hearing aids, or cochlear implants, cocktail parties become an unnavigable sea of babble.

“It can really affect communication,” says Gerald Kidd, a BU professor of speech, language & hearing sciences. “It causes people to avoid those kinds of places, either because they don’t want to work that hard or it’s just unpleasant to be in a situation where they’re not following things. So it’s a big problem.”

Selective Listening

Kidd and his colleague Jayaganesh Swaminathan, a BU research assistant professor of speech, language & hearing sciences, study the cocktail party problem, trying to understand exactly why this particular situation is difficult for so many people. Their research, funded by the National Institutes of Health (NIH) and the Air Force Office of Scientific Research (AFOSR), and published in Scientific Reports in June 2015, asked an intriguing question: can musicians—trained to listen selectively to instruments in an ensemble and shift their attention from one instrument to another—better understand speech in a crowded social setting?

“Music places huge demands on certain mechanisms in the brain, and at some levels, these overlap with language mechanisms,” says Aniruddh Patel, a professor of psychology at Tufts University and co-author on the paper, who studies the cognitive neuroscience of music and language. “The question is: would a high level of musical training advance speech and language as well?” In other words, can musical training help fix the cocktail party problem? Continue reading

You’re Not Lazy, You Just Quickly Minimize Exertion, Study Suggests

A new study finds we quickly change our gait for greater efficiency. (Peter Mooney/Flickr)

A new study finds we quickly change our gait for greater efficiency. (Peter Mooney/Flickr)

By Josh Eibelman
CommonHealth intern

If you’re feeling guilty and blaming yourself for being lazy, take heart: We evolved to minimize how much we move, and new research suggests we adjust our bodies quickly to expend the least possible energy.

In a new study, “Humans Can Continuously Optimize Energetic Cost During Walking,” published in the journal Current Biology, researchers found that people optimize their gaits — the manner in which they walk — in real time in order to expend less energy.

Subjects in the study were fitted with exoskeletons that forced them to walk in abnormal ways. The scientists found that participants automatically fine-tuned their manners of walking to more energetically efficient ones in response to the exoskeletons.

I spoke with Jessica Selinger, lead author of the study and a doctoral candidate at Simon Fraser University, to learn more.

How would you sum up your results?

What we found was that people quite readily will tune or change really fundamental characteristics of their gait — characteristics that have been established over millions of steps over the course of their lifetime — in order to move in a way that uses the least amount of energy.

That’s probably intuitive for a lot of us. We know that we like to do things that require the least effort and do them in the least effortful way. I might prefer to take a bus to work when I could walk or I might prefer to sit when I could stand. But what’s really interesting is that even when you make a conscious choice to exercise or spend energy, what our study shows is that your nervous system is optimizing and tuning behind-the-scenes your movements so that you’re burning the fewest calories possible.

What message do you want people to take away from these findings?

For one, it’s really remarkable that the body can do this. There are countless ways that someone could walk from point A to point B. We can choose different speeds, step rates and even muscle activity patterns, yet we have very strong preferences for particular gaits — the energetically optimal gait. It’s really amazing that our body is able to home in on what is the most energetically optimal way to move. It’s a complex problem and an impressive feat. You have to be smart to be that lazy!

And the other really interesting thing was that that people would adapt their gait even in response to very small savings in energetic cost. We’re talking about just a few percent of the body’s total energy use. It seems that the body is really sensitive to this measure. Energetic cost is not just an outcome of our movement, it is continuously shaping the way me move.

Can people do anything to counteract this laziness? Continue reading

Coming To A Clinic Near You: The $50 IUD With A Fascinating Backstory

The new Liletta intra-uterine device (Courtesy of Medicines360)

The new Liletta intra-uterine device (Courtesy of Medicines360)

Zoe Reiches got her first IUD this August — a new model with the lilting name Liletta.

Reiches, 25 and a human resources specialist in Boston, is now happily set for birth control for at least three years. “It’s convenient, I don’t have to worry about it, and I didn’t have to pay for it because of insurance,” she said. “I’m lucky in that sense.”

Millions more American women share her luck now that Obamacare has mandated birth control coverage with no co-pays for most insurers.

But the Liletta, which is just starting to roll out at clinics and hospitals here in Boston and around the country, is not only a device for the lucky — quite the opposite.

Its whole reason for being is to serve poor and uninsured women, to make IUDs — which can cost $1,000 or more — affordable to all, and available on demand at publicly funded health centers.

“This has never been done before,” said Jessica Grossman, the new CEO of Medicines360, the nonprofit pharmaceutical company behind the Liletta. “Our whole mission is to offer this low-cost product.”

Very low cost, compared to the usual thousand-plus dollars. At least until the end of the year, a special program guarantees that insured women who get a Liletta will pay no more than $75 out of pocket for it, Grossman said. A permanent patient assistance program will also provide Lilettas for free to women who qualify.

‘Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’

And, behind the scenes but even more important, public health clinics can order the Liletta for a mere $50 each.

In Massachusetts, all six Planned Parenthood clinics have begun to stock the Liletta, and it’s starting to enter “formularies” — the approved prescription lists — from major hospitals to cash-strapped community health clinics. Medicines360 reports shipping Liletta to 49 states, with more than half of the devices going to clinics that serve low-income patients.

The idea is to make the devices affordable enough that clinics can stock plenty, Grossman said, so that a woman can come in and say, “’Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’ ”

The Anonymous Donor

The Liletta is the latest chapter in the story of the great resurgence of IUDs in the United States, featuring billionaire investor Warren Buffett in a key cameo.

A New York City subway sign that is part of the new "Maybe the IUD" campaign (Courtesy of Dr. Deborah Kaplan)

A New York City subway sign that is part of the new “Maybe the IUD” campaign (Courtesy of Dr. Deborah Kaplan)

After the 1970s debacle of the Dalkon shield, which caused infections and even a few deaths, IUDs fell almost completely out of use among American women. Then, in 2001, a new, hormone-emitting device came on the market — the Mirena.

IUDs steadily gained popularity as a relatively safe, set-and-forget, long-acting but reversible option for many women. (As a no-complaints Mirena user for a decade, I’m one of them.)

More than 10 percent of American women who use birth control now choose IUDs, the most recent data show — the Mirena or the Skyla, which emit tiny amounts of hormones, or a simpler copper IUD, the Paragard.

The latest evidence of the IUD’s full rehabilitation: New York City’s Health Department this week launched its “Maybe the IUD” campaign to encourage New York women to consider an IUD.

The campaign talks about “reproductive justice,” reflecting in part a troubling trend: Unintended pregnancy is increasingly a poor woman’s problem. Look at the trend in the Guttmacher chart below: Continue reading